New international research published in lancet e-clinical medicine mapped global blood transfusion practices for life-threatening abdominal injuries, highlighting significant differences in care around the world and opportunities for health systems to learn from each other.
The study was led by the University of Cambridge as part of the GOAL-Trauma study and analyzed data from 1,768 patients treated at 187 hospitals in 51 countries. This is the first multicenter study to report on blood transfusion strategies for patients undergoing emergency abdominal surgery after trauma (trauma laparotomy).
Uncontrolled bleeding is the leading cause of death after abdominal trauma, making optimal blood transfusion a critical component of care. However, this study found significant variation in how blood is administered across resource settings.
Hospitals with more resources were significantly more likely to use component therapy, a process that separates donated blood into packed red blood cells, plasma, and platelets. In contrast, whole blood transfusions, in which the blood is used without separation, were more than twice as common in low-resource settings.
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Although whole blood has been routinely performed in many low-resource hospitals for decades, it has recently gained renewed interest in high-income trauma systems.
The researchers suggest that clinicians in low-resource settings have accumulated substantial practical experience in organizing blood donations and performing whole blood transfusions in emergency situations, and that experience may help inform its safe and effective use elsewhere.
For us, whole blood has long been a routine part of trauma resuscitation because it is easy to store and provide quickly. It is encouraging to see international data recognizing its continued role in trauma care. This supports continued efforts to strengthen trauma systems in settings like ours. ”
Dr. Joachim Amoako, Senior Lecturer/Vascular and General Surgeon, University of Ghana
Availability of low-cost, life-saving drugs is limited.
The study also found lower overall intake of tranexamic acid (TXA), an inexpensive drug known to reduce deaths from traumatic hemorrhage when given early.
Despite being recommended as an essential medicine by the World Health Organization, TXA is used in less than 30% of cases worldwide, highlighting ongoing challenges in translating clinical evidence into routine practice.
“One of the concerning findings was the low levels of tranexamic acid used,” said Professor Timothy Hardcastle of the University of KwaZulu-Natal in South Africa. “TXA is an inexpensive and widely available drug with strong evidence that early administration reduces deaths from traumatic hemorrhage. It is routinely used for obstetric hemorrhage and is often available in low-resource settings. However, fewer than one in three patients received TXA overall. Improving early use of proven and affordable treatments like TXA has the potential to make a meaningful difference in trauma outcomes around the world.”
The researchers conclude that understanding these global variations is an important step toward developing context-specific blood transfusion guidance and planning future international studies. They suggest that further research into the role of whole blood is essential to ensure that trauma patients receive effective early care regardless of their situation.
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Reference magazines:
Ng, W.-H. Others. (2026). Preoperative blood product use in abdominal trauma: a planned secondary analysis of the GOAL trauma study. EC clinical medicine. DOI: 10.1016/j.eclinm.2026.103814. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00061-1/fulltext.
